| 摘要: |
| 目的 观察罗哌卡因局部浸润联合右美托咪啶预防性镇痛用于膝关节镜手术后镇痛的有效性和安全性。方法 将90例择期膝关节镜手术患者按随机数字表法分为对照组（Ⅰ组）、静脉自控镇痛（PCIA）组（Ⅱ组）和预防性镇痛组（Ⅲ组），每组各30例。Ⅰ组手术结束时不给予任何镇痛药物；Ⅱ组手术结束前10min予PCIA（芬太尼1000μg以0.9%氯化钠溶液稀释至100ml）；Ⅲ组手术前皮肤消毒后，由手术者以0.5%罗哌卡因24ml于切口处分别浸润，手术结束前10min静脉泵注右美托咪啶0.5μg/kg。患者回病房后如静止相（患侧膝关节保持静止时）视觉模拟评分（VAS）≥5分，予哌替啶1mg/kg肌肉注射。测定患者术后1、4、8、12、24、48h静止相和运动相（患侧膝关节活动时）VAS评分；记录各组使用哌替啶的例数和剂量；记录各组患者苏醒期躁动、术后48h内深度镇静及恶心、呕吐等不良反应的发生情况。结果Ⅱ组静止相各时点VAS评分均明显低于Ⅰ组（均P＜0.05）；Ⅲ组静止相及运动相各时点VAS评分均明显低于Ⅰ组（均P＜0.05），运动相各时点均明显低于Ⅱ组（均P＜0.05）。Ⅱ组、Ⅲ组苏醒期躁动发生率均低于Ⅰ组（均P＜0.05）；术后48h内恶心、呕吐发生率Ⅱ组高于Ⅰ、Ⅲ组（P＜0.05）。结论罗哌卡因局部浸润联合右美托咪啶预防性镇痛用于膝关节镜手术患者术后镇痛是有效和安全的，且优于术后PCIA。 |
| 关键词: 罗哌卡因 局部麻醉 右美托咪啶 预防性镇痛 膝关节镜 |
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| Comparison of preventive analgesia of ropivacaine local infiltration analgesia in combination with dexmedetomidine and patient-controlled intravenous analgesia as postoperative analgesia following arthroscopic knee surgery |
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lV Yinhu
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Third Hospital of Xiaoshan District
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| Abstract: |
| Objective To compare the effectiveness and safety of preventive analgesia of ropivacaine local infiltration analgesia in combination with dexmedetomidine and patient-controlled intravenous analgesia(PCIA) for postoperative analgesia following arthroscopic knee surgery. Methods Ninety patients scheduled for arthroscopic knee surgery were randomly assigned to 3 groups: control group (groupⅠ), patient controlled intravenous analgesia group (group Ⅱ) and preventive analgesia group (group Ⅲ) with 30 in each. In group Ⅱ, patients accepted PCIA (fentanyl 1 000μg diluted with 0.9% normal saline to 100 ml) 10min before the end of operation; in group Ⅲ, incision infiltration with 0.25% ropivacaine 24 ml was given before operation and dexmedetomidine 0.5μg/kg was injected intravenously 10min before the end of operation; patients in group I were not given any analgesia after surgery. Degree of pain at resting and motion were estimated using the visual analogue scale (VAS) at 1h, 4h, 8h, 12h, 24h, 48h after operation. The incidence of dysphoria during recovery period, throat pain, lethargy, nausea, vomiting after operation were recorded. Results Both in the groupⅡ and group Ⅲ the resting VAS score in all time points were significantly lower than that in groupⅠ (P＜0.05); in group Ⅲ the resting VAS score at most time points and the motion VAS score in all time points were significantly lower than those in groupⅡ (P＜0.05). Both in the groupⅡ and group Ⅲ the incidence of dysphoria during recovery period and throat pain after operation were significantly lower than those in groupⅠ (P＜0.05); the incidence of nausea and vomiting in group Ⅱwere significantly higher than that in groupⅠand group Ⅲ (P＜0.05). Conclusion Preventive analgesia of ropivacaine local infiltration analgesia in combination with dexmedetomidine for postoperative analgesia following arthroscopic knee surgery is effective and safe, and superior to PCIA. |
| Key words: Ropivacaine Local anesthesia Dexmedetomidine Preventive analgesia Arthroscopic Knee surgery |
